Failure to Progress and Preparing for a VBAC
For most mammals birth seems to be fairly straightforward. They seek a safe and private place to birth in the middle of the night. Some choose to birth alone and others have ‘midwife mammals’ by their side. If there is danger they either have a speedy birth or stall labour until there is another safe opportunity.
For humans, it seems far more challenging. We have to feel safe in our environment, safe with the people around us, and safe with the physical and emotional process that is taking us over. We have learnt to fear birth with our minds and hearts, yet nature requires us to feel safe in order to give birth. Sometimes ‘failure to progress’ is the result of this struggle.
‘Failure to progress’ is one of the common reasons given for a caesarean during labour. This label is a blanket term for times where contractions have slowed or paused, dilation has gone backwards, or contractions are continuing but the baby is making no further progress towards birth. Women’s stories suggest that the label ‘failure to progress’ is often used when their labour has taken several days, or simply longer than expected or allowed by policy.
There are many variations in labour and doctors and midwives face the task of judging when medical assistance is needed and when all that is needed is patience. No one wants an adverse outcome, however in the rush to keep birth safe, some mothers and babies are hurried into treatment for an emergency that just does not exist. Some caesarean births due to failure to progress are actually caesareans due to impatience and failure to wait.
“After 50 hours of intense labour, I had a caesarean.
I haemorrhaged and my uterus collapsed requiring manual internal manipulation to contract it back down again. I had to have the caesarean under general anaesthetic because of my previous spinal surgery – I was unconscious for the birth of my baby.
My husband was allowed into surgery to be with our baby. I’m glad of that, because I wasn’t ‘there’.
The last thing I remember was being pregnant. Next thing I knew, at least a couple of hours later, I was being wheeled up a corridor past a baby in a clear plastic crib and someone was saying, “That’s your daughter.”
It was a very surreal and disjointed experience. To this day, I still feel a gap. I don’t feel like I birthed my daughter, yet she’s gorgeous and I love her like I’ve never loved anyone or anything before.
It should not have happened this way. It was an unnecessary caesarean performed due to medical impatience with my long posterior labour. Neither my precious daughter nor myself were at risk during labour except when they intervened.”
From Jo’s VBAC story “Triumphant Birth”, in Birth Journeys – positive birth stories to encourage and inspire
The alternative response to a labour that seems to be failing to progress is to ask what obstacles are there to this birth. If a mother feels frightened, threatened, nervous, embarrassed, angry, unsupported, alone, disempowered, violated, exposed, worried, overwhelmed or any other negative feeling then this can slow her labour down and even stop her labour from progressing.
Women’s birth stories show that there are many ways to help a birthing mother to move through or let go of thoughts or influences that have made her feel unsafe or threatened if this is the cause of a slowed or stalled labour:
– a change in environment (can she leave the room, open or close the curtains, change the atmosphere if not location)
– a change in activity and pace (get moving if she has been still, be still if she has been moving)
– a challenging question (eg, what is it you are frightened of? What are you avoiding? Is she intentionally avoiding the intensity of labour mentally or physically by avoiding certain movements or positions that make her contractions more intense and more effective?)
– the removal of an unwelcome person in the room (is there an uninvited or irritating presence in the room? If it is a midwife or nurse, can you ask for a different one or buffer her from this person’s impact)
– or the inclusion of a loved and longed for person (is she missing someone special?)
a few simple encouraging words (you are made to do this, you are bringing your baby into the world, positive affirmations)
– a description of what her body is doing or needs to do (open up and let your baby come down)
– a cry (release the built up stress so she can feel ready to birth her baby)
– a reminder of the skills she has learnt and the strength she has to give birth and to be a mother (has she forgotten the birth skills she has learnt? Or is she worried that she doesn’t have the ability to be a mother to this baby?)
– some time alone (maybe she needs some quiet space to reflect and gather herself. A trip to the toilet seems to work well according to women’s experiences!)
Preparing for your next birth
It is important to understand the factors that contributed to the path of your last birth and to consider the possible impact your feelings (whether you felt safe or unsafe) had on your labour. It is wise to discuss your previous birth in detail with your chosen doctor/midwife for a birth after caesarean. Pay attention to the way your chosen carers talk about your past birth as this will tell you what you can expect from them.
If your doctor seems to blame you and your body for a failure to progress, then be wary of both the doctor and the truth of what they are saying. Keep in mind that a very, very tiny percentage of women actually have a physical reason why they cannot labour and birth vaginally and statistically you are unlikely to be this woman.
If you hear words like “Your pelvis is too small and your baby got stuck. Luckily we saved your baby’s life just in time. You’ll never be able to have a vaginal birth of course” then you can thank this carer and start looking for another! They have just revealed that they are unaware of or insensitive to the emotional issues around birth and they already believe you and your body ‘failed’. You could enquire about the evidence for their verdict or you could simply put this energy into finding a more supportive and respectful doctor first. There are ways to discuss a ‘failure to progress’ that would be more supportive, caring and respectful.
One doctor or midwife’s ‘failure to progress’ will be another’s call to action: how can I help you to feel safe enough to give birth?